Provider Demographics
NPI:1386954584
Name:RADTKE, INA (MD PHD)
Entity type:Individual
Prefix:DR
First Name:INA
Middle Name:
Last Name:RADTKE
Suffix:
Gender:F
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 BELL LN
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TN
Mailing Address - Zip Code:38242-7997
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:300 HOSPITAL CIR
Practice Address - Street 2:SUITE 1031
Practice Address - City:PARIS
Practice Address - State:TN
Practice Address - Zip Code:38242-4504
Practice Address - Country:US
Practice Address - Phone:731-642-1220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-21
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0520532085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology